Insurance Claims Management & Medical Bills Review Solution

Client Overview

One of the largest Third-Party Administration (TPA’s) Group of Companies from USA who is focused to partner with Insurance Companies, Managed Care Companies, Bill Review Companies, Self-Insured/ Self-Administered Entities and craft effective and thorough insurance solutions for variety of business needs. Client offers access to full suite of Insurance services that are focused on getting best possible outcomes for their customers’ business.
The client is One of the largest Third-Party Administration (TPA’s) Group of Companies from USA. The company specializes in providing insurance administration services in the area of Claim management, Medical Bill Review, Policy Administration, and Risk Management.

Business Challenge

  • All essential administration processes handled manually
  • Disorganized operations and management solutions
  • Increased complexity of manual claims, follow ups, bills review and payment approval processes
  • Increased need of medical cost containment

Solution Highlights

  • Built and integrated insurance claims and medical bills review solution
  • Real-world workflow solution with focus on easy access to relevant information to maximize productivity and ROI
  • Bill review system and claims management system offer multiple entry methods
  • The review processing form automatically re-prices lines in real-time as fields are populated as it references U&C rates, state-specific fee schedules, and customizable coded rules with EMB codes
  • Bills are automatically queued for transmission to a customizable configuration of PPOs in daily batches
  • System supports payment scheduling, Reserve Fund Management and Authorization, claim/document storage and retrieval
  • One-Click CMS reporting, retrieval, and correction for Medicare. An industry-leading CMS management interface means there is never a need to visit the Medicare website for reporting submission or retrieval
  • Robust reporting, including detailed loss runs, can be accessed by administrators
  • Complete control over customer access experience for each screen allowing them to access the information you allow
  • Claim Management
  • Robust reporting, including detailed loss runs, can be accessed by administrators
  • Complete control over customer access experience for each screen allowing them to access the information you allow

Benefits

  • Stay on top of growing needs of the insurance industry
  • Manage the entire remittance process and streamline downstream processes to save time and money
  • Eliminated the manual claims status checks process in medical claims management and bill review
  • Better checks and balances for payment approvals
  • Automated validation of the claims with compliance
  • Identify errors and avoid long turn-around time
  • Minimizing revenue leakage
  • Boosting clean claims rates
  • Automatic Medicare submission